2009年10月8日 星期四

Top 10 Mistakes Made in Clinical Rotations

Last week, I watched a med student argue for 20 minutes with a patient about whether or not they were ambulating enough. His actions inspired me to make a top 10 list of mistakes that I've seen students make during their clinical rotations:

1. Arguing with a patient.This is an exercise in futility, and is very unprofessional.

2. Reporting a physical finding without actually observing it.I've even seen a student get in trouble for documenting a physical finding on a patient who had been discharged already.

3. Pimping your resident or attending.Med school is similar to the military when it comes to respecting your place in the chain of command. Attendings pimp residents and med students. Residents pimp med students. Thou shalt not pimp up the chain.

4. Disrespecting the nurses.Seriously, this is a huge no-no. If you want to make your life miserable, make the nurses hate you. If you want to enjoy your time at the hospital, befriend every nurse you meet.

5. Dressing inappropriately.I've seen this rule broken many times, and yet it never fails to shock me. We've probably all seen at least one female wearing 4-inch stiletto heels, or showing so much cleavage that you could use their chest to make an anatomical drawing. There's a time and a place for everything, and the hospital is not a place to dress provocatively.

6. Documenting an important positive finding without alerting your resident or attending.If you discover that a patient has rebound tenderness, or a temperature of 103.7, don't write this in a note and walk away. You must always alert your higher-ups to significant findings, or else you will find yourself getting chewed out for a good while.

7. Showing up late.This is a particular pet peeve of mine, and one that some students seem to think is insignificant. People notice when you're late. It's unprofessional and disrespectful to the rest of the group. Traffic is not an excuse. Leave your residence early enough to get to the hospital with plenty of time to spare.

8. Performing a procedure without having been authorized to do so.If the resident walks in on you placing a central line on a patient without their authorization, you will find yourself in deep trouble with the doctor, hospital, and potentially a courtroom.

9. Forgetting you are in a hospital.This is something that is easier said than done. We spend so many hours in the hospital that it's easy to forget that we are surrounded by very ill people. It's not a high school football game; it's a hospital, people.

10. Being a slacker.We all have seen students who try to get by with the bare minimum in everything they do. If you want to throw away a ridiculous amount of money, not learn anything, and end up being a crappy doctor, then by all means slack off during your clinical years. If you want to learn a lot and become an incredible doctor, then put in the time and effort.